genortГений ортопедииGenij Ortopedii1028-44272542-131XЦЕНТР ИЛИЗАРОВА10.18019/1028-4427-2024-30-2-263-272MARSUCgenort-2965Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWПерспективные костно-пластические материалы и хирургические технологии при реконструктивно‑восстановительном лечении больных с псевдоартрозами и дефектами костной тканиPromising osteoplastic materials and surgical technologies in reconstructive treatment of patients with bone nonunion and defectshttps://orcid.org/0000-0003-3720-5467БорзуновД. Ю.BorzunovD. Yu.

Дмитрий Юрьевич Борзунов — доктор медицинских наук, профессор, профессор кафедры

Екатеринбург

Dmitry Yu. Borzunov — Doctor of Medical Sciences, Professor, Professor of the Department

Ekaterinburg

borzunov@bk.ruГильмановР. Т.GilmanovR. T.

Ринат Тимурович Гильманов — врач травматолог-ортопед, ассистент кафедры

Екатеринбург

Rinat T. Gilmanov — traumatologist-orthopedist, assistant of the department

Ekaterinburg

Уральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationЦентральная городская клиническая больница № 23РоссияCentral City Clinical Hospital No. 23Russian Federation202428042024302263272Copyright © Борзунов Д.Ю., Гильманов Р.Т., 20242024Борзунов Д.Ю., Гильманов Р.Т.Borzunov D.Y., Gilmanov R.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ilizarov-journal.com/jour/article/view/2965Введение

Введение. В разработке инновационных имплантационных материалов для костно-пластической хирургии достигнуты определенные успехи, но в связи с сохранением высокой распространенности кататравм и травм, полученных в результате дорожно-транспортных происшествий, техногенных катастроф и военных действий, по-прежнему остается актуальной проблема замещения костных дефектов.

Цель работы — на основе анализа литературы выявить варианты решения проблемы замещения костных дефектов с использованием материалов, разработанных на принципах ортобиологии, и хирургических технологий, основанных на аутологичных репаративных процессах.

Материалы и методы

Материалы и методы. Поиск источников осуществлен с использованием аналитического инструмента ConnectedPapers и возможностей электронной библиотеки eLibrary по ключевым словам, без ограничений по дате публикации.

Результаты и обсуждение

Результаты и обсуждение. В публикациях, вышедших за последнее время, имеются сведения об эффективности комбинации технологии Masquelet и транспорта кости по Илизарову у пациентов с приобретенными и врожденными дефектами, в том числе в условиях активной гнойной инфекции. По данным литературы, перспективным аутологичным костно-пластическим материалом является содержимое костномозговой полости, содержащее остеогенные факторы роста, костные морфогенетические белки. Забор биоматериала осуществляют при помощи Reamer-Irrigator-Aspirator system (RIA) из интрамедуллярного канала бедренной или большеберцовой кости. В настоящее время фактически доказана эффективность костных морфогенетических белков rhBMP-2 и rhBMP-7 в восстановительном лечении пациентов с костными дефектами и ложными суставами различной этиологии. Применение костных морфогенетических белков введено в зарубежные протоколы лечения. Полученные в последнее время позитивные результаты комбинации хирургических технологий позволили предложить совместное применение технологий Илизарова и Masquelet и дополнить его использованием PRP-терапии. Основанием для ожидаемого эффекта от комбинации применения хирургических технологий и ортобиологических материалов являются результаты доклинических исследований остеогенного потенциала PRP-терапии.

Заключение

Заключение. Имеются основания для изучения клинического эффекта комбинированного применения хирургических технологий, основанных на аутологичных репаративных процессах, и материалов, разработанных на принципах ортобиологии. Необходимо и целесообразно клиническое внедрение использования костных морфогенетических белков rhBMP-2 и rhBMP-7 в реконструктивно-восстановительном лечении пациентов с костными дефектами и ложными суставами различной этиологии. Необходимы мультицентровые клинические исследования с высоким уровнем доказательности по определению эффективности PRP-терапии при восстановительном лечении пациентов с костными дефектами и ложными суставами.

Introduction Some progress has been made in the development of innovative implantation materials for  osteoplastic surgery. However, the problem of bone defect management still remains relevant due to the continued high prevalence of injuries resulting from road accidents, catatrauma, man-made disasters and military operations.

The purpose of the work was to analyze the relevant literature and to identify options for solving the problems of  bone nonunion and defect management using materials developed on the principles of orthobiology and surgical technologies based on autologous repair.

Materials and methods The search for sources was carried out with the ConnectedPapers analytical tool  and  the  capabilities of the eLibrary electronic library using keywords and without restrictions on publication date.

Results and discussion Recent publications contain information about the effectiveness of the combination of  Masquelet technology and Ilizarov bone transport in patients with acquired and congenital defects, including in the conditions of active purulent infection. According to the literature, a promising autologous bone plastic material is the contents of the bone marrow cavity, containing osteogenic growth factors and bone morphogenetic proteins. Biomaterial is collected using the Reamer-Irrigator-Aspirator system (RIA) from the intramedullary canal of the femur or tibia. Currently, the effectiveness of bone morphogenetic proteins rhBMP-2 and rhBMP-7 in the restorative treatment of patients with bone defects and nonunion of various etiologies has actually been proven. The use of bone morphogenetic proteins has been introduced into foreign treatment protocols. Recent positive results of a combination of surgical technologies have proposed the  combined use of the Ilizarov and Masquelet technologies, supplemented by PRP therapy. The basis for  the  expected effect from the combination of surgical technologies and orthobiological materials are the results of preclinical studies of the osteogenic potential of PRP therapy.

Conclusion There are grounds for studying the clinical effect of the combined use of surgical technologies based on autologous reparative processes and materials developed on the principles of orthobiology. It  is  necessary and advisable to clinically implement the use of bone morphogenetic proteins rhBMP-2 and  rhBMP-7 in the reconstructive treatment of patients with bone defects and nonunion of various etiologies. Multicenter clinical studies of a high level of evidence are needed to determine the effectiveness of PRP therapy in the reconstructive treatment of patients with bone nonunion and defects.

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The authors declare that there are no conflicts of interest present.